Individual
AMANDA WISIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, PMHNP
Contact information
Practice address
10160 W 50TH AVE UNIT 4, WHEAT RIDGE, CO 80033-2339
(720) 669-3470
Mailing address
8181 E TUFTS AVE STE 560, DENVER, CO 80237-2559
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
0011133
CO
101YP2500X
Professional Counselor
7142009-6004
UT
101YP2500X
Professional Counselor
LH 60290236
WA
2084P0800X
Psychiatry Physician
0011133
CO
2084P0800X
Psychiatry Physician
RN.1659896
CO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0998730
CO
390200000X
Student in an Organized Health Care Education/Training Program
1659896
CO
390200000X
Student in an Organized Health Care Education/Training Program
RN.1659896
CO
Other
Enumeration date
10/31/2012
Last updated
01/03/2024
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